Part 1 Designing Resistance Training Programs. Part 3 Considerations for Strength Training in Young Athletes

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1 Part 1 Designing Resistance Training Programs 1. Strength Training in Endurance Sports 2. Training Recommendations 3. Case Study Part 2 Training for Speed and Agility 1. Introduction to Speed and Agility 2. Methods Used in Training for Speed and Agility 3. Case Study Part 3 Considerations for Strength Training in Young Athletes 1. Benefits and Risks 2. Definition of Terms 3. Safety Considerations 4. Sample Exercises 5. Guidelines for Youth Strength Training Programs 6. Case Study for Junior Athlete Part 4 Post Sports Medicine Advanced Rehabilitation in FTC

2 Strength and conditioning STRENGTH AND CONDITIONING The ultimate goal of the strength and conditioning professional is to help athletes achieve their maximal physical performance potential without incurring injury. The nature of every sport is different as far as tactical, technical, as well as physical requirements. With regards to the designing of training programs there is not one recipe for all sports, nor is there one program for any particular sport or individual, as individuals playing the same sport can also vary greatly. Many coaches and athletes often inquire about the best strength and conditioning program for their sport, but the first answer to their question is usually the same. While there are training programs suitable to meet the needs of most athletes in a certain sport, it would be dangerous and ineffective to apply a blanket training program to athletes at the elite level. This is not to say that making an optimal program for an athlete is not possible, but it is not as simple as just pulling a program out of a hat. Much more investigation about the athlete s personal abilities, sport experience, injury history, physical qualities, and task-specific needs is a first step. Designing an optimal strength training program requires knowledge and information from many sources. Understanding the individual athlete generally requires a team, or rather, a multi disciplinary approach. That is, the coach s feedback, preliminary health screening information from sports medicine, various testing from sports science, and a psychological profile of the athlete from the sports psychologists. Armed with this information, the strength and conditioning professional must then have a good understanding of the sport he/she is working with from a physical perspective in terms of energy system requirements, body biomechanics, and distinctive movement needs. The information from sports medicine and sports science provides information about the individual s particular physical strengths and weaknesses and this is then compared with the requirements of the sport. In this way, we can improve our chances of developing the most effective training program for the each athlete, taking into account his/her individual physical attributes or limitations. Strength and conditioning covers both the physical strengthening of athletes through various modalities of resistance training as well as designing and applying programs to improve the physical conditioning of the athlete in terms of aerobic and anaerobic conditioning, agility, speed, and quickness. As the field of strength and conditioning may in some ways be broad and cover many aspects of physical training, the scope of the following pages will focus more on the training programs of some special groups including recommendations for training of youth athletes, in addition to strength training for endurance athletes and for athletes of power and speed sports. Within each section a case study will be included. While each case is based on fact, in order to protect the identification of the sport, coaches, and athletes, and other individuals involved in each case, some information has been altered. PART 1 DESIGNING RESISTANCE TRAINING PROGRAMS The first step in a program design is to perform a needs analysis. This process includes an evaluation of the requirements and particular characteristics of the sport and an assessment of the individual athlete. Evaluation of the sport can be achieved in a number of ways including literature research, observation, input from coaches, or visual feedback from video recordings (or high speed cameras if greater detail is required). The sport evaluation will include a movement analysis, a physiological analysis, and an injury analysis. For many of the common sports, such analyses are not necessary as much information already exists in the literature. The second step is to make a profile of the athlete s needs and goals by evaluating training and injury status and also conducting a number of tests (maximal or submaximal strength and/ Handbook of Support Services for Elite Sport in Hong Kong : An Integrated Multi-disciplinary Model 144 / 145

3 or muscle endurance tests), analysing the results and then determining the primary goal of the athlete. Through testing it often becomes apparent that due to underlying weaknesses and imbalances, the initially desired goal of the coach or athlete may need to be postponed. Faulty body mechanics and muscle imbalances will lead to future injuries, so due attention must be given to these areas as a priority. 1. STRENGTH TRAINING IN ENDURANCE SPORTS Athletic movements that utilise large muscle groups and need to be sustained for at least two minutes in duration are generally considered to be under the domain of endurance sports. Examples include rowing, triathlon, marathon, and road race cycling. To excel in endurance events, the athlete needs a high level of maximal aerobic capacity (VO 2max ) and lactate threshold, good economy of movement and optimal levels of muscle endurance, and to some degree that of strength and power, in particular when it come to the starts and finishes of races. Figure 8.1 For many years, strength training was not popular among endurance athletes. The demands and adaptations to strength training and endurance training are on two extremes of the spectrum. It is commonly thought among practitioners of endurance sports that training for both strength and endurance has kind of a cancellation effect on each other. Strength training stimulates increases in muscle fiber size, decreases capillary density, and decreases mitochondrial volume. In contrast, endurance training stimulates increase in capillary density, increases mitochondrial volume and leads to a decrease in muscle fiber size. Research on simultaneous strength training and endurance training has been mixed but it appears that concurrent strength and endurance training has no adverse effect on development of aerobic capacity, but only hinders gains in maximal strength and power. This finding is very important for the endurance athlete, as it was once thought that doing weight training would reduce Max VO 2. Benefits of strength training include increases in strength of muscles and connective tissues (like tendons, ligament and bones). This helps decrease the risk of injury. Reducing injury risk is one of the most important factors for endurance athletes. Furthermore, recent studies indicate that strength training improves running economy, thus enhancing sports performance. Nowadays, more endurance athletes accept the idea that strength training is good for their sport and incorporate strength training into to their training program. It is also important to note that strength training does not only include the use barbells, dumbbells and weight stack machines. Other equipment may also be used such as medicine balls, Swiss balls, or performing uphill or downhill runs or bike, or resisted or assisted swims and other physical activities using some form of resistance (or assistance). 2. TRAINING RECOMMENDATIONS Assess the athlete s individual needs and goals. Pinpoint weaknesses and give these areas first priority for strengthening. If an athlete needs more muscle strength and power, then the strength training program needs to be given priority to the endurance training of the sport. However, it is more common that an endurance athlete puts priority

4 Strength and conditioning into training that improves aerobic capacity and the strength training program would then be less frequent and more of a maintenance in injury prevention program. Strengthen the major muscles in the upper and lower body including the core musculature (i.e. that of the abdominal and lower back regions). Progress gradually by increasing the level of difficulty or intensity while decreasing volume. Start from general strength exercises (like leg press or squat) and progress to more sport-specific movements (like 1-leg squat, 1-leg hops, swim bench). Movement speed should progress from slow speed to fast speed. Plyometric exercises and uphill runs are preferably used to increase muscle power. Gradually lessen strength-training sessions and include more specific exercise movements towards the latter part of the cycle and allow more time to focus on sport skills. Include rest days or weeks and light sessions for recovery from intense training. This is also seen in tapering, or the lowering of training volume while maintaining the intensity of training sessions. Tapering is emphasised about a week or two before a major race or competition. Complement other training programs. Coordinate strength training with other parts of the conditioning program (like prehabilitation/rehabilitation, flexibility, cardiovascular endurance or mental training). Strength training should not take away time from beneficial sport-specific work by including activities that will not help and may even hinder performance development. Maintain a training log to monitor response and adaptation to training. Periodisation manipulate volume and intensity systematically in a strength training cycle to facilitate optimum effects from the program. Athletes may start building up aerobic capacity in the off-season, then develop muscle strength in the early pre-season (high-resistance, slow-speed), followed by exercises and drills developing power in the late pre-season (low-resistance, high-speed) like plyometrics and high intensity interval training. Preventive or rehabilitative exercises are preferably performed throughout the year. Season Phase Goal Load (% 1RM) Sets Reps Rest Speed Off Season Base period Prepare body for harder work ahead sec. Slow Pre-season Strength phase Develop maximum strength 85* min. Slow to moderate Power phase Improve power min. Fast Endurance Improve muscular endurance sec. Moderate In-season Maintenance phase** Maintain power and/ or endurance Power maintenance Maintain power min. Moderate to fast Endurance maintenance Maintain endurance sec. Moderate Table 8.1 Sample strength training periodisation for endurance sports * Load applies to primary or complex exercises (e.g. Squat, Bench press). Assistance exercises (e.g. Arm Curl, Leg Extension) should be limited up to 80% of 1 RM. * May alternate power maintenance phase with endurance maintenance phase. Handbook of Support Services for Elite Sport in Hong Kong : An Integrated Multi-disciplinary Model 146 / 147

5 3. CASE STUDY A lightweight rowing athlete presented a bodyweight of 75 kg, which was still 3kg above his required 72 kg competition weight. As improper dieting would lead to loss in bodyweight with concomitant loss in lean body tissue, a proper nutrition program had to be included along with his training program. Muscle reduction for this athlete had to be minimised, as loss in lean body tissue would also lead to losses in power and strength. The first step in our process was to sit down with the relevant parties, which included representatives from sports physiology, sports nutrition, sports psychology, strength and conditioning, the sport coach, and sports medicine. It was determined through this interaction that before establishing the most suitable program for this athlete we initially needed the athlete undergo a nutritional and body fat assessment, responsibilities falling under the domain of the sports nutritionist. Body fat was measured at approximately 9% using a skinfold formula. There was some room for reduction in body fat, but we had to make sure that weight losses came primarily from fat and not from muscle and water only. As lightweight rowers have restrictions for their maximal weight, it was important to design a strength training program which allowed the athlete to get stronger but have minimal effects on muscle hypertrophy. Therefore, in the off season, we focused on strength and power training as opposed to muscle endurance or hypertrophy training. We had the rower train within ranges of 4-6 RM for 3-4 sets, which brought about improvements in strength with only minor increases in muscle mass. The training program concentrated on rowing specific muscles such as legs, back, and arms. Most of the primary movements in the training were be done with multi-joint exercises such as power clean, power pulls, dead lifts, squats, leg press, bench pulls, and chin ups. Special focus was also given to the trunk region, as it has been shown that a weak core (i.e., trunk musculature) will not only increase the changes of injury, but will not provide a strong link in the kinetic chain between the arms, which apply force to the oar, and the legs, which apply force on the foot stretcher in the boat. We found that training was best arranged in the late morning, so as not to hinder afternoon technical training. If any aerobic exercises were included within the weight training session, it should come at the end. Preferably, however, 2-3 hours rest was allowed between sessions to allow for adequate recovery. Competition rowing is primarily aerobic in nature, but as mentioned above, the inclusion of resistance training should not hinder the development of the aerobic system. While carrying out all resistance training in a sports specific manner, such as adding resistance to the boat, may lead to some degree of strength gains for the rower, such practice on a regular basis may not be advisable because the inherently awkward and unsafe flexed position of the spine during rowing should not be continuously overloaded for extended periods of time. When athletes become tired, they will compensate their technique and injury will occur. If sports specific strengthening is used, it is more advisable to add this type of training in a progressive manner or preferably on a rowing ergometer, as the loading can be fixed and the tendency for slippage of the oar in the water as a result of faulty blade work will not happen. As the rower progressed through the program, his weight was checked each morning upon waking up. His body fat measurement was reassessed every two weeks and diet carefully scrutinised. He also monitored on a daily basis in training and had follow up ergometer tests every two weeks in the lab to make sure he was not dropping in power output due to reduction in bodyweight. Strength was not measured via testing, but rather regular monitoring during the training program, as testing required too much of the athletes time and was not seen as necessary.

6 Strength and conditioning Within two months the athlete was able to reach his competition weight, reducing body fat to approximately 6-7%. There may have been slight decrease in muscle mass as well, but as a result of the training program there were still increases in overall strength and endurance. PART 2 TRAINING FOR SPEED AND AGILITY 1. INTRODUCTION TO SPEED AND AGILITY Speed is a major factor in explosive sports (sprinting, jumping, striking). It is also important in sports that require a quick response to different situations (team sports, racket sports). Its impact is further reduced in endurance sports (marathon, road cycling). In a sport such as sprinting, which is performed linearly, i.e. from point A to point B only, it is important to achieve and maintain maximum speed for as long as possible. However, in most team and racket sports, in addition to speed it is just as important to have agility. Speed is defined as the ability to perform a movement quickly, while agility pertains to the ability to stop and go quickly while changing directions, maintaining good balance when shifting your center of mass. Training for speed and agility make use of the anaerobic (no oxygen) alactic acid (no lactic acid) systems, or the phosphagen system. These programs usually involve maximal intensity efforts of less than 10 seconds with almost complete recovery in between so that lactic acid does not accumulate. Training modalities to improve speed and agility include strength-training, plyometrics, movement coordination drills, as well as drills for improving form and technique. Exact training will be based on the specific skills required for the sport. Definition of terms Speed is the ability to perform movement quickly. This is important in sprinters, platform or springboard divers or table tennis athletes. Agility is the ability to explosively stop, change direction and accelerate again. This is seen in team sports like basketball, water polo, and racket sports like tennis. Speed-strength is the maximal force that can be developed rapidly at high speed. This is power at very fast speed, i.e., movements like hitting a baseball, jumping for a volleyball block or avoiding a blow. Training for speed-strength will require maximal efforts with lighter loads of approximately 40%RM. If the weights are too light, then the ability to produce power will be diminished and it will be a pure speed, rather than speed-strength exercise. Acceleration is the ability to achieve maximum speed quickly. Speed-endurance is the ability to provide energy for maximal acceleration or speed, and during repeated efforts of maximal intensity activities. An athlete with good speed-endurance will be less likely to slow down late in the game or after a sprint, as this ability will delay the onset of fatigue. Examples of activities include repeated fast-breaks in basketball, prolonged rallies in badminton or squash, and rowing. Handbook of Support Services for Elite Sport in Hong Kong : An Integrated Multi-disciplinary Model 148 / 149

7 2. METHODS USED IN TRAINING FOR SPEED AND AGILITY Developing speed and agility is specific to the demands of the sport. In some sports, the maximum sprint speed is never reached like basketball and squash. For this reason attention should not be focused on speed alone, but rather on other skills like agility, starting ability, acceleration, speed-strength (achieved through strength and power training), and speed-endurance. Strength and power training Weight training with medium to heavy resistance, low repetitions and complete rest between sets is used to improve power or maximum force output. Many commonly used power exercises are derived from the Olympic lifts. These include such exercises as the high pulls, power cleans, or snatches. They are explosive actions involving multiple joints and muscle groups that are performed in a coordinated manner. Cleans < Start End > Figure 8.2 Figure 8.3 Plyometrics involve the stretch-shortening cycle that is seen in cocking of the arms and shoulder before hitting a tennis ball or throwing a punch. Examples of plyometric exercises include box jumps, bounding, depth jumps and medicine ball chest passes or overhead passes. These exercises help the muscle to reach maximal strength in a short time by storing energy in the muscles during the rapidlengthening (stretch) and immediately releasing the energy in the opposite direction (shortening). Plyometrics improves power as well as skills like agility, starting ability and acceleration. To avoid injuries the athlete should have a sufficient strength base. Movement drills Agility drills are exercises that include multidirectional movements with starts, stops, and rapid changes in directions. Sports-specific skills may also be incorporated in skills like passing or dribbling a ball (basketball) or adding a front kick (taekwondo). Examples are shuttle runs, ladder drills and sport specific plays in basketball. Form and speed endurance Figure 8.4 Ladder drills A sound technique is taught to the athlete early on using lower speed and intensity (approximately 75% maximum). Proper position of the body and the extremities is important to make movements more efficient and effective. For example, the position of the hand in relation to the forearm, arm and shoulders in the stroke mechanics of swimming. The intensity is gradually brought to 100% as techniques are mastered.

8 Strength and conditioning Other anaerobic training Methods used for speed-endurance training include interval training methods and repetition sprints. These activities involve maximal or near-maximal efforts that may last from 10 seconds to 3 minutes depending on the training goal. Recovery intervals, or the time between repetitions, are manipulated according to the goal. For example, when training the anaerobic alactic energy system, work intervals last from 10 to 60 seconds with complete recovery between repetitions, around 1-3 minutes rest intervals. Usually a work to rest ratio of about 1:4 or 1:5. These exercises usually cover a sport specific distance. Resisted loading is the addition of weight to either your bodyweight or the implement used in the sport. For example Figure 8.5 wearing a weight vest during sprints, running uphill, and using heavier bats in baseball practices. The additional weight may range from 1 to 20 pounds. Again, the weight should not be too heavy that it affects proper skill and technique, nor should it be so heavy that the movement becomes slow and cumbersome. Loading applies methods to artificially increase the speed of movement to improve stride frequency. These methods include downhill running, treadmill running or high speed towing. Figure 8.6 Sled towing assisted To achieve the appropriate training effects, proper mechanics of movement should be strictly maintained while using the resisted or assisted methods of training. Below are some general guidelines that should be considered when undertaking a speed and agility program. 3. CASE STUDY A badminton coach presented a junior female athlete who he felt had good speed but was not able to change directions very well. As we had not worked with this athlete before, we consulted with the Sports Medicine Department about her health profile to see if she had any underlying areas of injury or other concerns. The athlete s medical screening was normal, so we then inquired from Sports Science Department whether this athlete had undergone any testing battery before. Since she had not, we needed to implement some basic tests to give up more information about her physical background. We carried out a sprint test using electronic timing as well as a few agility tests and found that the coach was correct. The linear speed of the athlete was excellent among her peers, but her ability to change directions was not as good. She seemed to lack balance and strength, and possibly some coordination, when shifting bodyweight.the strength and conditioning coach then asked the sport coach to describe the athletes training program and what kind of exercises she has been doing to help the athlete improve agility. Since the main focus of improving agility had been on-court training, this type of training may have overlooked the athlete s weak area, as the athlete may have compensated in other ways by adjusting technique and tactics. Agility is difficult to measure, because as a badminton player the variability in movements is immense. In order to get a closer look at the athletes movement, the Sports Biomechanist was brought in to take some high speed videos. In contrast to those who Handbook of Support Services for Elite Sport in Hong Kong : An Integrated Multi-disciplinary Model 150 / 151

9 changed directions quickly and well, it seemed this athlete lacked strength in certain leg muscles. A full assessment of the athletes leg strength was then carried out in Sports Medicine and Sports Science Departments. Weak trunk muscles, poor unilateral balance, and weak leg external rotators and abductors were concluded. It also appeared that the athlete did in fact have weak posterior tibialis, which led to falling arches, femur internal rotation, and poor balance. For the training program, we would first work on bilateral strength of the legs and then shift to unilateral strength. At the same time the athlete worked on balance training with foam rubber pads and balance boards, and was asked to pay attention to the dropping of the arches at all times. At the same time low intensity (then building up to higher intensity) short bursts of direction change activities was recommended for on court training, paying special attention to proper body coordination and not allowing compensatory movements to occur. This case was not a very difficult one and due to the young age of the athlete, she was able to quickly strengthen her weak areas and within 4-6 weeks was moving better than her peers. PART 3 CONSIDERATIONS FOR STRENGTH TRAINING IN YOUNG ATHLETES The number of children participating in sports continues to grow. To be competitive, young athletes need to be physically fit and have high levels of sport skills. Strength training is one way of improving a child s physical fitness. It is a method of conditioning designed to increase the ability to exert or resist force. Strength training uses a variety of equipment like body weight (push up, chin up), free weights (dumbbell, barbell) or weight machines (leg curl, lat pull). Figure 8.7 Push-up Start Medical and health professionals agree that strength training can be beneficial and safe for both prepubescent and adolescents. Prepubescent refers to children between the period of infancy and adolescence. Adolescents refer to those that are between the period of childhood and adulthood where they start to develop the secondary sexual characteristics (e.g. pubic hair). Strength training is distinct from weight lifting, power lifting or bodybuilding. Weight lifting is a competitive sport that involves maximum lifting (1RM) ability at higher speeds and a considerable level of skill is required. Olympic weightlifting includes the snatch and the clean and jerk. Power lifting is a competitive sport that also involves maximum lifting (1RM) ability at slower speeds and with heavier weights. It includes the deadlift, the squat, and the bench press. Furthermore, bodybuilding is a competitive sport in which muscle size, symmetry, and definition are judged, as opposed to lifting ability. Strength training program for young athletes may include the same exercises as those seen in weightlifting, powerlifting or bodybuilding but loads are submaximal (at most 80% 1RM).

10 Strength and conditioning 1. BENEFITS AND RISKS Recent studies have shown that injury risk is low and that properly designed and supervised strength training can increase muscle endurance and strength, strengthen bones, improve body composition and motor skills, protect against injury, and also have a positive psychological benefit for children. Most importantly, there appear to be no negative effects to the child s linear growth as a result of undergoing a strength program. Many fractures to the growth plate (area of developing tissue near the ends of long bones in children and adolescents) are caused by acute trauma (falls from a height, or blow to the body). Some are cause by repetitive use. However, such cases have not occurred in any prospective youth strength training study, which followed established strength training guidelines. In fact, resistance training may actually make bones stronger. Young athletes with hypertension may experience further elevation of blood pressure from isometric demands of the exercise. 2. DEFINITION OF TERMS Resistance or strength training Repetition Set Rest/recovery One Rep Max (1RM) Frequency The use of progressive resistance methods (body weight, free weights, machines, etc.) to increase one s ability to exert or resist force. One complete action of an exercise (up and down) A group of repetitions separated by scheduled rest periods. The period of time taken between sets, between exercises or between sessions. The maximum amount of weight that can be lifted once in good form. The number of training sessions completed in a specified period of time. 3. SAFETY CONSIDERATIONS Safety is of utmost importance when considering resistance training for children, as careless and unsupervised training could lead to injury. Following are some important things to keep in mind. Follow established training principles (i.e., overload, recovery, specificity, etc.) and emphasise correct form and technique. More stress cannot be put on the point of correct form and technique. Many coaches, in an attempt to mimic the programs of elite athletes, will overload their preadolescent athletes in hopes of achieving accelerated success. This is a formula for disaster. Not only must children train progressively, but also they must be mentally and emotionally ready to receive and follow instruction. Therefore, as a general rule, avoid heavy training loads (1 repetition maximum), ensure adequate rest, and provide qualified instruction and competent adult supervision. In addition to good supervision and sensible training methods, the exercise environment must be safe and free of hazards and equipment should be well maintained and properly sized to fit the young athletes. It is usually not recommended for preadolescents to do much lifting overhead. However, in cases where lifting a weight over the body, a spotter should be in position and should be able to communicate with the lifter. As a general guideline, the optimum ratio of supervisor to children is 1:10. All programs should also include good warm-up and cool-down. Handbook of Support Services for Elite Sport in Hong Kong : An Integrated Multi-disciplinary Model 152 / 153

11 4. SAMPLE EXERCISES Dumbbell Squats < DB Squat-start DB Squat-end > Figure 8.8 Figure 8.9 Lunges Dumbbell bench press Dumbbell rows Dumbbell curls Tricep push down Back extension Crunches Cross crunches A properly designed and supervised strength training program is now recognised as an important component of youth fitness program, promotes health and may prevent sports injury provided that appropriate guidelines are followed.

12 Strength and conditioning 5. GUIDELINES FOR YOUTH STRENGTH TRAINING PROGRAMS 1. Recommend medical examination especially those who have known or suspected health problems. 2. The child should understand the benefits and risks associated with strength training. 3. Provide competent adult instruction and supervision. 4. Exercise environment should be free of hazards. 5. Include warm up and cool down. Figure 8.10 Stretch quadriceps 6. Teachers and/or coaches should listen to each child s concerns and answer any questions. 7. Begin with 1 light set, reps, 8-12 exercises that focus on the major muscle groups (lower body, upper body and core musculature abdominal and lower back). 8. Depending on the individual s needs and goals, give 6-15 repetitions, 1-3 sets of a variety of exercises. 9. Start with a light weight when learning correct technique using controlled movements though the full range of motion. 10.Multi-joint exercises may be incorporated into the program using appropriate loads and emphasising proper form. Figure 8.11 MB Chess Pass 11.Choose from a variety of strength training modes like: Free weights (barbell, dumbbell) Body weight exercises Weight Machines Medicine Balls Stability Balls 12.Increase intensity gradually as strength improves. Figure 8.12 Skip rope 13.Schedule 2-3 non-consecutive training sessions per week about minutes per session. 14.Incorporate into overall conditioning program (endurance, flexibility etc.) and practices with sports skills. 15.The resistance-training program should be systematically varied throughout the year. Handbook of Support Services for Elite Sport in Hong Kong : An Integrated Multi-disciplinary Model 154 / 155

13 16.Encourage them to drink plenty of water before, during and after exercise. 17.Children should avoid competing against each other; instead they should be encouraged to feel good about their own success. 6. CASE STUDY FOR JUNIOR ATHLETE A group of young male tennis athletes between the ages of 9-12 were brought to the Strength and Conditioning Department for training. The coach felt that some systematic strengthening program would be beneficial. In the desire to have athletes strengthen as rapidly as a possible, young athletes are often started on weight training too soon and with loads that are too heavy. There are some downsides to doing this. Firstly, applying heavy loads too soon could result in undue injury. Secondly, young athletes that are still trying to gain a good grasp of their sports skills will often compensate their strength and/or stamina for lack of a good set of skills. As many coaches know, this leads to very adept junior athletes who will soon be overtaken by their peers that begin to focus on a systematic strengthening program after they have mastered a good set of skills. This is quite noticeable when one considers how quickly a young female athlete will pick up a new technique while her male counterpart is still muscling his technique. For these reasons, the strength and conditioning coach recommended that these tennis youngsters first learned to control their bodies and improve their strength initially with bodyweight alone. After carrying out some basic bodyweight tests, we found that the majority of these young athletes could not do a good set of proper push ups but had already been doing exercises such as bench press, where entire body coordination and trunk strength are minimised. We also noted that the athletes presented very weak abdominal and lower back endurance when doing some basic clinical trunk endurance tests. We then planned a resistance training program that used only bodyweight and medicine balls for a six-week period. We also decided that we would not advance the athletes to weight training until they could do a minimum of 10 (F=female) and 15 (M=male) proper push ups and modified pull ups, 60 no-load squats, and were able to reach above average level on the clinical trunk endurance tests. After following the program for eight weeks, all athletes achieved the minimal level to start their weight training program. Since the athletes were still quite young, intensities were allowed no higher than 50-60% RM, and particular emphasis was put on proper technique. Large muscle group exercises made up the core of the training program. These exercises were done primarily with free weight, as machines require less proprioceptive challenges, limit planes of motion, and are often not the right size for young athletes. Figure 8.13

14 Strength and conditioning PART 4 POST SPORTS MEDICINE ADVANCED REHABILITATION IN FTC To enhance optimum performance enhancement training of athletes, injury preventive exercises and strategies are included in the training programs. Exercises are given to: correct muscle weakness and imbalances improve balance and proprioception increase range of motion increase muscle and soft tissue flexibility, and increase joint stability The best strategy for rehabilitation may be to prevent the injury from occurring in the first place. The Strength and Conditioning Department also helps injured and recovering athletes train so as to minimise the training time lost. When an athlete is injured and is undergoing rehabilitation by the Sports Medicine Department, we are informed about the case and how it is being managed. Depending on the management and recommendations by the doctor the athlete may continue strength and conditioning training without adding stress to the injured part. The athlete trains other body parts not injured or related to the injured part. This is to avoid significant detraining effects due to the usual rest that will be recommended. After the athlete has gained functional capacity of the injured part the Sports Medicine Department refers the athlete for further advanced rehabilitation. This is rehabilitation training over and above the usual functional demand of the rehabilitated body part. Emphasis will first be on the improvement of the proprioceptive sense of the injured part. This is done using different modalities that will challenge the sense of balance and proprioception. Balance boards, foam mats, stability balls and other equipment are used to train and develop the stability of the joints or body parts involved. Training is coordinated with the Sports Medicine Department, which gives some recommendations and/or restrictions for the training of the recovering athlete. Advance rehabilitation training programs must be: Safe Challenging Multi-Sensory Approach Sport Action Specific Coordination and cooperation with the coaches and the Sports Medicine Department make it possible for the athlete to return to sport not only faster but safer as well. Handbook of Support Services for Elite Sport in Hong Kong : An Integrated Multi-disciplinary Model 156 / 157

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